MEDICARE: MR. CHRISTOPHER MICHAEL CHILDS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	P0183	TX

General Provider Information

NPI Number	:	1851676928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MICHAEL CHILDS D.O.

Provider Business Mailing Address
First Line	:	520 SAMUELS AVE APT 7308
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-8629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 SAMUELS AVE APT 7308
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-8629
Country	:	US
Telephone Number	:	830-285-3822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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